Esophagitis is inflammation, irritation or swelling of the esophagus, the tube that moves food from the mouth to the stomach. It may produce symptoms such as heartburn, abdominal discomfort, nausea and painful swallowing.

Esophagitis is most often caused by a common condition called gastroesophageal reflux diseasegastroesophageal reflux disease (GERD) in which the contents of the stomach flow back (reflux) into the esophagus and damage its lining. Some medications may also cause esophagitis, either as a side effect of their therapeutic use or by becoming lodged in the esophagus. Less common causes of esophagitis include infections, allergic reactions and chemotherapy or radiation treatment for cancer.

Many factors can increase a person’s risk of developing esophagitis, including pregnancy, cigarette smoking and being overweight. People with certain other diseases may also be prone to developing esophagitis. These include diabetes, the autoimmune condition scleroderma and conditions characterized by frequent vomiting.

Esophagitis may be diagnosed by a physician during a physical examination that includes a medical history and certain diagnostic tests (e.g., endoscopy).

Treatment of esophagitis depends on its cause. In cases caused by GERD, patients may incorporate lifestyle changes to treat (or prevent) esophagitis. These include avoiding eating meals too close to bedtime, quitting smoking and avoiding alcohol. Patients may be treated with medications for GERD, such as foaming agents, H2 blockers or proton pump inhibitors.

Patients who do not respond to lifestyle changes and medications may require surgery (e.g., fundoplication) to correct the condition.

In some cases, early detection and treatment of GERD may help prevent the onset of esophagitis.

Esophagitis is a general term that refers to inflammation, irritation or swelling of the esophagus.

Esophagitis is frequently associated with a common condition called gastroesophageal reflux disease (GERD) in which the contents of the stomach flow back (reflux) into the esophagus and damage its lining. For that reason, GERD is sometimes called reflux esophagitis.

The esophagus is a muscular tube that transports food from the mouth to the stomach. A special group of muscles at the end of the esophagus serves as a valve between the esophagus and the stomach. The muscles are called the lower esophageal sphincter (LES). When food reaches the LES, the LES relaxes and allows the food to enter the stomach. The LES then contracts to prevent food and other stomach contents from backing up into the esophagus.

When food reaches the stomach, it produces acids that help digestion. The stomach contains special linings that protect it from the constant exposure to these gastric juices. Linings in other parts of the digestive tract, such as the esophagus, are not as resistant. When the LES is weakened or remains relaxed for too long, contents of the stomach can reflux into the esophagus. When the esophagus is exposed to stomach acid over a prolonged period, its lining can become damaged.

Other conditions may also damage or inflame the esophagus, including infections, poorly swallowed pills or exposure to caustic substances such as lye. Recent research has verified that a type of esophagitis called eosinophilic esophagitis (EE) can result from  an allergic reaction, which leads to the presence of white blood cells called eosinophils in the esophagus.

If not treated properly, esophagitis can lead to serious complications, such as:

• Esophageal ulcers. Continued erosion of the esophageal lining may cause ulceration.
  
  
• Bleeding. Bleeding may occur as a result of ulcers.
  
  
• Difficulty swallowing (dysphagia). If severe, this can lead to malnutrition, dehydration and/or weight loss.
  
  
• Stricture. Abnormal narrowing of the esophagus caused by scarring and repeated inflammation.
  
  
• Barrett's esophagus. Precancerous condition in which the cells lining the lower part of the esophagus are changed or replaced with abnormal cells. In rare cases, this condition can lead to esophageal cancer.
  

Recent research also indicates that patients with esophagitis are significantly more likely to develop esophageal cancer than those without the condition.

By far, the most common cause of esophagitis is gastroesophageal reflux disease (GERD). This is a common condition in which the contents of the stomach flow back (reflux) into the esophagus and damage its lining.

Hiatal hernias may also contribute to GERD and esophagitis. A hiatal hernia occurs when the upper part of the stomach pushes above the diaphragm, the muscle that separates the stomach from the chest. The diaphragm supports the lower esophageal sphincter (LES), the muscles that act as a valve between the esophagus and the stomach. A hiatal hernia allows stomach acid to back up into the esophagus.

There are several less common causes of esophagitis including:

• Persistent vomiting. Patients who vomit frequently after meals may develop esophagitis because stomach acid in vomit can harm the esophagus. This may occur among patients with eating disorders such as bulimia nervosa and those with cyclic vomiting syndrome, which mostly affects children.
  
  
• Medications. Medications such as some nonsteroidal anti-inflammatory drugs (NSAIDs) and osteoporosis pills can cause a chemical burn in the esophagus, especially if they become lodged there or are not swallowed with sufficient liquid.
  
  
• Allergic reactions. In recent years, physicians have identified cases of esophagitis caused by the presence of white blood cells called eosinophils. The allergic reaction that produces this eosinophilic esophagitis (EE) is not well understood, but researchers have identified a subset of genes believed to play a role in the development of EE. The condition occurs in both adults and children, but is more common in children.
  
  
• Infections. Viruses (such as herpes or cytomegalovirus), fungi and yeasts such as Candida can infect the esophagus and cause esophagitis. This typically happens in patients with weakened immune systems, such as those with acquired immunodeficiency syndrome (AIDS).
  
  
• Corrosive substances. The esophagus can be harmed when caustic substances such as drain cleaner or lye are ingested.
  
  
• Cancer treatments. Chemotherapy and radiation therapy for cancer can damage the esophagus. The symptoms from this type of esophagitis may appear immediately after treatment or weeks or months later.

Many conditions increase the risk of a person developing GERD, which also increases their risk of developing esophagitis. Some of these risk factors include:

• Alcohol. Alcohol stimulates acid production and may contribute to a more relaxed LES.
  
  
• Excess body weight. Being overweight can increase pressure on the abdominal muscles and the stomach.
  
  
• Pregnancy. Both the pressure of increased weight and increased levels of the hormone progesterone, which relaxes muscles, can contribute to acid reflux.
  
  
• Cigarette smoking. Smoking reduces the production of saliva, which helps neutralize stomach acid. Coughing provoked by smoking can trigger episodes of reflux. In addition, the nicotine in cigarettes helps relax the LES.
  
  
• Certain foods and beverages. Traditionally, physicians have recommended that patients with GERD avoid certain foods and beverages, including citrus fruits, chocolate, fatty foods, spicy foods, tomato sauce, mint and carbonated and/or caffeinated beverages, which may increase acid production or relax LES muscles. However, recent research questions the necessity of such dietary changes.
  
  
• Certain medications. Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), sedatives, tranquilizers  and calcium channel blockers (medication to treat high blood pressure) can cause reflux. Recent research also indicates that taking a certain type of sleeping pills may also increase the risk of developing nighttime heartburn.
   
• Other diseases. GERD occurs more commonly with certain diseases, although the relationship is unclear. Some of these diseases may be characterized by lower levels of pressure on the LES, which allows stomach acid to reflux. Some people with conditions that delay the emptying of the stomach, such as diabetes, experience GERD and also experience esophagitis. One form of scleroderma, an autoimmune condition that primarily affects the skin, may also cause esophageal problems.

The most common symptom experienced by patients with esophagitis is heartburn, a burning sensation in the upper abdomen or chest area caused by contact with stomach acid. Some patients may experience this as chest pain and may mistakenly belive that it is caused by heart problems.

Other common symptoms of esophagitis include upper abdominal discomfort, nausea and bloating. Less commonly, esophagitis may affect swallowing, making it difficult or painful. Coughing, hoarseness and wheezing are other uncommon symptoms. When there is bleeding in the esophagus, patients may notice blood in vomit or in their stool, or blood tests may indicate they are anemic from blood loss.

The treatment of esophagitis depends on its cause. Gastroesophageal reflux disease (GERD), a condition in which stomach contents flow back (reflux) into the esophagus and damage its lining, is by far the most common cause of esophagitis. Therefore, early detection and treatment of GERD may help prevent the onset of esophagitis.

Patients may make the following lifestyle changes to treat (or prevent) reflux and promote esophageal health:

• Avoid foods that may cause reflux, such as spicy foods and fatty foods, although some experts question the necessity of such dietary changes.
  
  
• Avoid eating meals too close to bedtime. Meals should be consumed at least two to three hours before bedtime. Some experts contend that lying down makes reflux worse, although there is little evidence to support this.
  
  
• Take pills with adequate amounts of liquid and do not lie down immediately after taking pills.
  
  
• Eat smaller meals. This helps prevent the stomach from being too full. A full stomach may cause reflux.
  
  
• Raise the head of the bed 6 to 8 inches (15.2 to 20.3 centimeters). Elevating the head and shoulders over the stomach allows gravity to prevent acid from refluxing. Propping the head up with pillows will not help reflux and may increase pressure on the stomach or esophagus.
  
  
• Quit smoking.
  
  
• Avoid alcohol.
  
  
• Lose weight. Being overweight may worsen the condition.

Physicians also use medications to treat esophagitis. Esophagitis caused by an infection may be treated with antibiotics or other medications. In cases related to GERD, medications used may include:

• Foaming agents. They are available over the counter and work by covering the contents of the stomach with foam to prevent reflux.
  
  
• H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over the counter and by prescription.
  
  
• Proton pump inhibitors. Medications that reduce the amount of acid in the stomach by inhibiting its production. They are available over the counter and by prescription.

Steroids have shown to be of some benefit in patients with eosinophilic esophagitis, an allergic condition known to cause esophagitis.

Patients who do not respond to lifestyle changes and medications, particularly those that have complications due to esophagitis, may require surgery. Patients may have strictures that narrow the esophagus. A physician may use balloons or other devices to dilate the opening. In severe cases, patients are treated with a surgical procedure called fundoplication. This involves wrapping the upper part of the stomach around the lower esophageal sphincter (LES) to strengthen it and prevent acid reflux. The procedure can be performed laparoscopically. A few tiny incisions are made in the abdomen and a laparoscope is inserted. A laparoscope is a thin tube with a video camera and it can be fitted with surgical instruments.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about esophagitis:

1. I have gastroesophageal reflux disease (GERD). Should I be worried about developing esophagitis?
   
   
2. What are the chances I will develop Barrett’s esophagus as a complication of esophagitis?
   
   
3. What caused my case of esophagitis?
   
   
4. Will an endoscopy cause me any pain or discomfort?
   
   
5. Do you plan to perform a biopsy during my endoscopy?
   
   
6. What lifestyle changes should I make to treat my esophagitis?
   
   
7. Should I take medication to treat my esophagitis?
   
   
8. What type of medication is best for me?
   
   
9. What are my treatment options if my esophagitis does not respond to medication?
   
   
10. What are some ways that I can prevent my esophagitis from getting worse?